Migraine Medications for Kids

There are safe and effective treatment options that can improve your child's migraines. Symptoms of childhood migraines include headaches, vomiting, stomach aches, irritability, and fatigue. Parents and children might not always recognize the effects of a migraine, but treating these episodes at an early stage can help alleviate hours, or even days, of pain and discomfort.

After you and your child discuss the symptoms with your child's pediatrician, you can agree about what to do when a migraine occurs. If the migraines are frequent, you may need to discuss a preventative strategy as well.

If your child complains of occasional head pain, you may have tried over-the-counter Tylenol (acetaminophen), Advil (ibuprofen, or Aleve (naproxen). These medications, when taken as directed, can be effective for migraines in children. Children's doses are based on weight. The instructions for calculating the right dose are included on the box, often with measuring cups for liquid formulations.

If your child has other symptoms, such as nausea, or does not improve with over-the-counter pain medications, however, it may be time to consider prescription options.

• Anti-nausea medications: For children, migraines can manifest with stomach discomfort, abdominal pain, aversion to food, nausea, or vomiting. Over-the-counter and prescription antiemetics like Zofran (ondansetron) can relieve these symptoms. Antiemetics can also relieve other migraine symptoms, such as headaches.
• Triptans: Triptans are potent prescription medications, used for the treatment of moderate to severe migraine episodes. A few triptans, including Zomig (zolmitriptan) nasal spray, Axert (almotriptan), and Maxalt (rizatriptan), are approved for children. Your child's doctor will give you specific instructions regarding how much your child should take, when and how often the dose can be repeated, and when to call about side effects.
• Periactin (cyproheptadine): An antihistamine, cyproheptadine has long been used for childhood migraines. It has been recommended as a preventative medication, and it can be used for the treatment of an acute attack as well. Because cyproheptadine can cause sedation and increase appetite (causing weight gain), some people prefer not to use it every day and take it only for the treatment of acute migraine attacks.

Be sure to use medications as directed. Taking excessively high doses or taking migraine medication too frequently can backfire, triggering more migraines. When medication wears off, symptoms can occur, potentially triggering rebound headaches or medication overuse headaches.

Taking the medication right at the start of the symptoms is the best way to prevent a migraine attack from worsening. Your child may need to talk to the teacher and go to the school nurse if symptoms begin during school.

It is worthwhile for you to talk with your child about the various symptoms that occur with his or her migraines and to try to identify the earliest signs. Some children experience a prodromal stage before a migraine reaches its peak. Symptoms during the prodromal stage can include dizziness, stomach aches, photophobia (sensitivity to light), phonophobia (sensitivity to sound), osmophobia (sensitivity to smell), irritability, and sleepiness.

If your child is taking over-the-counter or prescription migraine medications more than 8 days a month on average, this is a high frequency of migraines. This could be due to medication overuse or to other factors. It would be worthwhile to discuss the idea of taking daily preventative medication instead of taking frequent medication for migraine attacks with your child's doctor.

Migraines can also interfere with your son or daughter's daily activities—if your child has four or more migraines a month that cause disability, such as missing school or other activities, this could be another reason to consider preventative management.

Migraines can be triggered by a number of factors, including stress and lack of sleep. As a parent, you can work with your child to figure out if any of these factors cause your child's migraines, and how to avoid them.

Common migraine triggers include:

• Lack of sleep
• Skipping meals
• Stress and anxiety
• Excessive computer and electronic use
• Caffeine intake
• Dietary triggers

Unless you find a specific dietary migraine trigger, putting your child on a restrictive diet is not a good idea. Kids can be pretty picky about food, and unnecessarily eliminating foods "just in case" won't prevent migraines.

Be sure to discuss your child's symptoms with his or her doctor before concluding that they are migraines. Some children have allergies, anxiety, or even medical problems can manifest in the same way as migraines. Once migraines are diagnosed, you can rest assured and focus on managing and preventing the episodes.

Talk to your pediatrician if your child's migraines worsen, change, or if your child develops new symptoms.